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PUBLIC WORKS <br /> & REVIEW WORKSHEET <br /> (ATTACH 1 SITE PLAN FOR REVIEW) Date: 7/27/2016 <br /> Permit#: PW1607-050 <br /> PROJECT ADDRESS: 25 104TH ST SE <br /> DESCRIPTION OF WORK: SITE DEVELOPMENT FOR NEW SFR <br /> CONTACT INFORMATION: <br /> OWNER: APPLICANT: <br /> NAME: NEAMTIU JAMES NAME: NEAMTIU JAMES <br /> ADDRESS: 10413 MERIDIAN AVE S ADDRESS: 10413 MERIDIAN AVE S <br /> EVERETT,WA, 98208 EVERETT,WA, 98208 <br /> PHONE: 4257809175 PHONE: 4257809175 <br /> EMAIL: NEAMTIUJAMES@YAHOO.COM EMAIL: NEAMTIUJAMES@YAHOO.COM <br /> CONTACT: ❑ Owner 0 Applicant ❑Other <br /> NAME: NEAMTIU JAMES <br /> PHONE: 4257809175 <br /> EMAIL: NEAMTIUJAMES@YAHOO.COM <br /> COMMENTS FROM PUBLIC WORKS REVIEWER: LAND USE PROJECT#: OS 1a—©©f <br /> PW Permit Required? YES 0 NO W.O.#: IP o2 — WI 2—001 <br /> Notes: Associated Bldg./PW Permit#: <br /> FIRE SPRINKLER REQUIRED?(by Fire Department/Code) <br /> ❑YES—Type (If yes, add to <br /> TRAKiT under Reviewer Comments <br /> f o_n_Bldg Permit and Stamp Drawings) <br /> Explaanation: fin,- C'rliC�f_ u� ZS0T C i~. �-1q 31341Z�1il <br /> (Note:Counter Staff to Create Utility Permit for any Water/Sewer/System Development Fees) <br /> WATER FEES? <br /> DOMESTIC SERVICE: FIRE SERVICE: <br /> ❑YES—Amount$ 0 YES—Amount$ <br /> ❑ Meter Only, 0 Complete Service, Size ❑3/" Detect Meter Only, ❑ Fire Service Size <br /> 151 NO L �'�I f1 c� �/ 0N <br /> Explanation: ,MS+d it e$ GU14' ( V 1507-V1 Explanation: <br /> ❑Water Department ost Estimate Needed-(/f yes, PW Reviewer to send cost estimate request to Water Department, attach copy) <br /> Existing Utility Permit#(if applicable): <br /> SEWER FEE? <br /> V YES—Amount$ . Q-Q- J New Connection, 0 Alteration/Repair, 0 Cap-off/Reconnect <br /> ❑ NO <br /> Explanation: <br /> Existing Utility Permit#(if applicable): <br /> SYSTEM DEVELOPMENT FEE? <br /> YES—Amount$ 9 10.�- 0 See Attached Spreadsheet <br /> ❑ NO—No Change of-Use/Other <br /> Explanation: N? SSFr-- 2-tri, y ' SF no U ' (errAtiznattl 110 EfrucluAZ <br /> (Note:Public Works Reviewer to Add Traffic Mitigation to PW Permit(if applicable)) <br /> TRAFFIC MITIGATION FEE? <br /> ❑YES—Amount$ 0 See Attached Spreadsheet <br /> )(NO ()WI W 1 36 -rIa -- Pwf60I-csa <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> V4 YES—TYPE SFS, ZSee Attached Letter <br /> ❑ NO <br /> Jjair* -71AR.VZ. gzog <br /> Public Works Reviewer Signature ate <br /> REVISED 2/24/2016 <br />